Implementing the Affordable Care Act to
Prepare and Expand a Primary Healthcare
Workforce
RADM Kerry Nesseler, MS, RN
Assistant Surgeon General
Director, Office of Global Health Affairs
Health Resources and Services Administration
U.S. Department of Health and Human Services
1
Human Resources for Health
•
WHO Health Workforce 2030:
Global Strategy on Human Resources
for Health - Draft
•
WHO Global Code of Practice on the International
Recruitment of Health Personnel
•
PAHO Strategy for Universal Access to Health and
Universal Health Coverage
•
U.S. Affordable Care Act (ACA)
2
Overarching Goals of the ACA
3
Health Resources and Services
Administration (HRSA)
Vision: Healthy Communities, Healthy People
Mission: Improve health and achieve health equity
through access to quality services, a skilled health
workforce and innovative programs
Goals:
1. Improve access to quality health care and
services
2. Strengthen the health workforce
3. Build healthy communities
4. Improve health equity
4
HRSA’s Bureau of Health Workforce (BHW)
Mission and Values
Collaboration
Improve the health of
underserved and
vulnerable populations
by strengthening the
health workforce and
connecting skilled
professionals to
communities in need.
Accountability
Innovation
5
Bureau of Health Workforce (BHW)
Workforce Supply
Priorities
Program
Design
1) Preparing a
Diverse
Workforce
2) Improving
Workforce
Distribution
3) Transforming
Health Care
Delivery
Academic & Community Partnerships
Interdisciplinary Practice & Training
Rapid Cycle Evaluation/Data Driven
Research and Resources
6
1) Preparing a Diverse Workforce
Diverse Workforce - Improved Quality
of Care
Greater diversity among health
professionals is associated with improved
quality of care for underserved
populations, including racial and ethnic
minorities and those from disadvantaged
backgrounds.
• 47% of trainees in BHW programs are
minorities and/or come from disadvantaged
backgrounds.
7
2) Improving Workforce Distribution
Training, Recruitment and Retention Improved Access in Underserved
Communities
Clinicians who receive training in
community-based and underserved settings
are more likely to practice in similar settings.
• 87% of NHSC clinicians continue to practice in
underserved areas, including rural communities,
up to two years after they complete their service
commitment.
8
3) Transforming Health Care Delivery
Modern Care - Improved Outcomes & Lower Costs
Changing service delivery to meet 21st century needs
through an emphasis on quality care that encourages
innovate team-based and interprofessional
approaches.
Our programs serve as a catalyst to advance changes
in health professions training that are responsive to
the evolving needs of the health care system.
• In Academic Year 2013-14, 12 BHW programs had
an interprofessional focus. Within those programs
1,315 clinical training sites were engaged in
interprofessional team-based care.
9
BHW
Division of Medicine and Dentistry
Goal: To strengthen the primary care workforce and promote practice in
rural and underserved areas.
Focus: to align with the needs of the ACA:
• Training for transforming health care systems
• Community-based training (Teaching Health Centers)
• Integrating geriatrics and primary care
• Integrating oral health and behavioral health and primary care
• Training for advanced roles, ex. dental hygienists
• Training future primary care researchers
Evaluation: increasing requirements for:
• Graduate outcomes, including specialty and location
• Patient service, quality of care, and cost effectiveness outcomes of
clinical training sites or grads
10
Teaching Health Centers
• Teaching Health Center Graduate Medical Education Program expands
residency training in community-based settings
•$230 million, five-year ACA initiative
•Increasing access to health care services for people who are
geographically isolated, economically or medically vulnerable
• 75% of Teaching Health Centers are FQHCs or Look-alikes
• $83.4 million in ACA funding for 2014-2015 academic year
•Training more than 550 residents in 59 Teaching Health Centers
•Expands states with Teaching Health Centers from 21 to 24
•11 Teaching Health Centers Graduate Medical Education programs in
7 states are NHSC sites
For the 2015-2016 academic year, HRSA is supporting approximately 690
residents.
FY 2016 Proposed New Physician
Training Programs
Rural Physician Training Grants Program ($4 million)
Recruits and trains physician students in rural
settings to increase the number of medical school
graduates who practice in rural communities
12
BHW
Division of Nursing and Public Health
Nursing Education Practice, Quality, and Retention (NEPQR) - Inter-professional Collaborative Practice (IPCP) Program
• Increase access to primary and team-based care
• Support the National Center for Interprofessional
Education and Practice
Advanced Nursing Education (ANE)
• Increase the number of primary care Nurse Practitioners
through the Advanced Nursing Education Traineeship
13
HRSA
National Health Service Corps (NHSC)
• The Affordable Care Act provided $1.5 billion to the NHSC over 5
years, providing flexibility in Corps requirements and increasing loan
repayments
• The Corps has more than doubled since 2008, from about 3,600 to
more than 9,200 primary health care professionals serving in over
4,900 sites
• NHSC providers care for about 9.7 million people in all 50 states;
nearly one-half practice in health centers
• More than 47,000 clinicians have served in the NHSC
14
NHSC by Discipline
28%
Mental Health
Providers
2% • Dental Hygienists
26%
Physicians
Nurse
Dentists
Practitioners
12%
18%
Physician
Assistants
12%
Nurse Midwives • 2%
*As of September 30, 2014
More than 9,200 NHSC primary care providers
serving at nearly 5,000 sites
15
2015 NHSC Participant Satisfaction Survey
Retention Rate
• NHSC Alumni who are…
1. At the same site where NHSC obligation was fulfilled
2. In same area where NHSC obligation was fulfilled (but different site)
3. In another site and shortage designation/area
• Retention Rate = 87% (up from 86% in 2014)
Top Reasons for Remaining or Leaving Site
Reasons for Staying
% Most Influential
Reasons for Leaving
% Most Influential
Experience at Site*
67%
Financial Considerations*
52%
Work/Life Balance
64%
Site Operations
49%
Salary
54%
Problems with Employer/Site
41%
16
Health Workforce Research and Resources
National Center for Health Workforce Analysis (NCHWA)
NCHWA research informs program planning and
development, and policy-making by examining
a broad range of issues that impact the nation’s
health workforce.
Six Health Workforce Research Centers
focus on:
• Long-term Care
• Allied Health
• Technical Assistance
• Oral Health
• Flexible use of workers to improve health
care delivery and efficiency
17
National Center for Health Workforce Analysis
Recently Published Reports:
•
•
•
•
•
•
•
•
The Future of the Nursing Workforce: National and State-Level Projections
2012-2025.
Highlights from the 2012 National Sample Survey of Nurse Practitioners
Sex, Race and Ethnic Diversity of US Health Occupations (2010-2012)
US Health Workforce: State Profiles
Projecting the Supply of Non-Primary Care Specialty and Subspecialty
Clinicians 2010-2025
National and State-Level Projections of Dentists and Dental Hygienists in the
U.S. 2012-2025
Distribution of U.S. Health Care Providers Residing in Rural and Urban Areas
Fact Sheets for Pharmacists, Occupational and Physical Therapists, Vision
Occupations, Chiropractors and Podiatrists, Nutritionists and Dieticians,
Psychologists, Respiratory Therapists and Health Care Support Workers
Upcoming Reports:
•
•
Projections on Primary Care Providers at National, Regional and State Levels:
Fall 2015
Projections on Behavioral and Mental Health: Work ongoing anticipated
release – Late Fall 2015
18
Center for Medicare and Medicaid
Innovation (CMMI)
•
•
•
•
•
•
FQHC Advanced Primary Care Practice
Demonstration
Comprehensive Primary Care Initiative
Transforming Clinical Practices Initiatives
Graduate Nurse Education Demonstration
Health Care Innovation Awards
State Innovation Models Awards
19
Center for Medicare and Medicaid
Innovation (CMMI) - Next Steps
•
•
•
•
•
The results from CMMI evaluations and the work of
entities such as the CC-IPECP at the University of
Minnesota can help define scope, impact, best practices
for integration
Will guide future policy and investments
The health care system will continue to evolve, as needs
evolve, and our thinking needs to be parallel to that
Organizations with expertise and willingness to invest are
empowered to do so now
Collaboration is key to success in these endeavors
20
Resources Available
• Marketplace Information and Enrollment
https://www.healthcare.gov/
• HRSA Affordable Care Act Website
http://www.hrsa.gov/affordablecareact
• HIV/AIDS Bureau Affordable Care Act Website
http://hab.hrsa.gov/affordablecareact
• Provider and Partner Marketplace Resources
http://marketplace.cms.gov
• From Coverage to Care Resources
http://marketplace.cms.gov/help-us/c2c.html
21
Contact Information
RADM Kerry Paige Nesseler, M.S., R.N.
Assistant Surgeon General
Director, Office of Global Health Affairs
Bureau of Health Workforce
Health Resources and Services Administration
U.S. Department of Health and Human Services
KNesseler@HRSA.GOV
22
Contact Information
Mr. Peter Mamacos
Director, Multilateral Relations
Office of Global Affairs
U.S. Department of Health and Human Services
Peter.Mamacos@hhs.gov
23